Clinical Report: Pediatric Hospitalizations for Acute Respiratory Viruses Post-COVID-19
Overview
This population-based cohort study from Ontario, Canada, analyzed pediatric hospitalizations for viral acute respiratory infections (ARIs) from 2017 to 2024. It revealed a sharp decline in ARI admissions during 2020/2021 due to COVID-19 mitigation, followed by atypical seasonality and increased hospitalizations in 2022/2023, especially for RSV and human metapneumovirus, with a near return to prepandemic patterns by 2023/2024.
Background
Viral respiratory infections, including RSV and influenza, are leading causes of hospitalization in children and typically follow predictable seasonal patterns. The COVID-19 pandemic and associated nonpharmaceutical interventions (NPIs) disrupted these patterns, causing near absence of many viral ARIs in 2020. Postpandemic years have seen atypical timing and intensity of viral ARIs, challenging healthcare capacity and public health planning. Understanding these changes is critical for managing pediatric respiratory illness burden.
Data Highlights
Season
RSV Admissions
hMPV Admissions
Influenza Admissions
Total Pediatric Population (approx.)
Prepandemic (2017-2019)
1969–2357
93–127
Not specified
~2.7 million/year
2020/2021
Sharp reduction
Sharp reduction
Mostly absent (n=168)
~2.7 million
2021/2022
Moderate return
Not specified
Mostly absent
~2.7 million
2022/2023
4701
377
Increased, part of tripledemic
~2.7 million
2023/2024
Seasonality nearly resumed
Not specified
Not specified
~2.7 million
Key Findings
COVID-19 mitigation measures in 2020/2021 caused a marked reduction in pediatric ARI hospitalizations, including near absence of influenza.
The 2022/2023 season saw an unprecedented surge in ARI admissions, particularly RSV (4701 admissions) and human metapneumovirus (377 admissions), exceeding prepandemic levels.
Postpandemic admissions involved older children on average (mean age 38.9–42.8 months vs 37.2–37.9 months prepandemic) and fewer males; males had significantly fewer than expected admissions in 2022/2023 (RR 0.63, 95% CI 0.57–0.70).
COVID-19 contributed minimally to ARI hospitalizations overall, especially in children under 5 years.
By 2023/2024, ARI seasonality appeared to nearly return to prepandemic patterns, though uncertainty remains about full normalization.
Clinical Implications
Clinicians should anticipate potential fluctuations in pediatric ARI burden following pandemic-related disruptions, with possible atypical timing and increased severity in certain seasons. Preparedness for surges, especially from RSV and other non-influenza viruses, remains essential. Monitoring evolving epidemiology will guide resource allocation and immunization strategies.
Conclusion
The COVID-19 pandemic profoundly altered the epidemiology and seasonality of pediatric viral respiratory infections, leading to unprecedented changes in hospitalization patterns. While some normalization occurred by 2023/2024, ongoing surveillance is critical to adapt clinical and public health responses.
References
Author/Source/Year -- Hospitalizations for Pediatric Acute Respiratory Viruses: A Cohort Analysis from 2017 to 2024
